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Neuro Emergencies Flashcards

1
Q

Head Trauma- history

A 
When, where & how
Mechanism of injury
LOC at the scene
Alcohol/drug involvement
Length of time from injury
Underlying medical problems
Allergies
Medications
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2
Q

Head trauma- physical

A 
Vitals
Glasgow coma scale
Examine for outward trauma
C-spine collar
Pupils
Level of alertness
Look for focal deficits
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3
Q

Clinical features of TBI

A 
\+ or - LOC, confusion or amnesia (legnth)
Headache
Dizziness, vertigo, imbalance
Disorientation
N/V
Vacant stare
Inability to focus
Gross incoordination
Memory deficits
Delayed verbal expression
Slurred or incoherent speech
Labile emotions
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4
Q

Complicated TBI issues

A 
Post-traumatic seizures
Focal neurologic signs
Neurologic deterioration
Worsening HA, confusion, focal neurological signs or lethargy
Other injuries to H&N
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5
Q

Guidelines for CT Scan in ER

A

GCS

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6
Q

CT scan abnormalities that require consult

A

Subdural hematoma
Intracranial bleeding
Cerebral edema
Significant skull trauma

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7
Q

Hospitalization or transfer

A

GCS

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8
Q

Outpatient observations warning signs

A 
Inability to wake patient
Severe or worsening HA
Somnolence/confusion
Difficulties with vision
Incontinence
Weakness/numbness
Unsteadiness or seizure
Vomiting, fever, stiff neck
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9
Q

Clinically significant skull fractures

A

Pass through sinus
Associated with scalp lesion
Depressed below the level of the skull’s inner table
Overlie a major dural venous sinus or middle meningeal artery

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10
Q

Depressed Fractures

A

Difficult to review on radiographs

Often can be felt

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11
Q

Basilar fractures

A

Linear fractures
Usually through the temporal bone
Fracture causes dural tear
CT for imaging

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12
Q

Signs of basilar fracture

A

Raccoon eyes
Battle’s sign
Hemotympanum

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13
Q

Definition of open skull fractures

A

An overlying scalp laceration and the dura is disrupted

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14
Q

Primary Headaches Syndromes

A

Migraines
Cluster HA
“Worst HA ever”

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15
Q

Characteristics of migraines

A 
Unilateral
Throbbing
Aura
Hx of migraines
N/V
Photophobia
Sound sensitive
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16
Q

Treatment of migraines

A

1st- Tryptans
2nd- Ketorolac + antiemetic
IV fluids

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17
Q

Characteristics of cluster HA

A

Men
Excruciating pain behind eye
Hx of cluster HA
Snot running out of nose

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18
Q

Treatment of cluster HA

A

1st- 100% oxygen

2nd- Sumatriptan

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19
Q

Thunderclap HA

A

Associated with N/V

+/- focal neurologic findings

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20
Q

Life threatening causes of HA

A 
Subarachnoid Hematoma
Bacterial Meningitis
Cerebral Ischemia
Subdural Hematoma
Brain Tumor
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21
Q

Seizure etiologies

A 
Alcohol associated
Metabolic
Infectious
Trauma
CVA
Sleep Deprivation
Noncompliance with anticonvulsant
First time idiopathic seizures
22
Q

Status Epilepticus Etiologies

A 
Hypo-natremia, -calcemia, -glycemia
CNS abscess
Meningitis/Encephalitis
Neoplasm
AV malformations
Actue hydrocephalus
Intracerebral hematomas
CVA
TCA's
Migraines
Failure to take anticonvulsant
23
Q

Seizure management

A 
Airway
Thiamine (alcoholic)
Hx of patient
Establish IV
1st- Benzodiazepines
2nd- Phenytoin, Phenobarbital
Possible dextrose bolus, Narcan
24
Q

SE of Phenytoin

A

Hypotension

Bradycardia

25
SE of Phenobarbital
Sedation Respiratory Depression BP depression
26
Post-ictal state
Sleepy/confused Often incontinent Tongue bitten
27
Vertigo Etiologies
Central Somatic Peripheral
28
Central vertigo etiologies
``` Migrainous Brainstem ischemia Cerebellar infarction Cerebellar hemorrhage MS ```
29
Somatic vertigo etiologies
Panic attack | Weak, dizzy, nearly fainting patient
30
Peripheral vertigo etiologies
``` Benign paroxysmal positional vertigo Vestibular neuritis Herpes zoster oticus Miner's disease Labyrinthitis Perilymphatic fistula Acoustic neuroma Aminoglycoside toxicity Otitis media ```
31
How long does peripheral vertigo etiologies last?
Few minutes to 3 hours and are recurrent
32
How long does central vertigo etiologies last
Hours to days
33
Define TIA
Brief stroke-like attack | Most symptoms last 5-20 minutes
34
Symptoms of TIA
``` Hemiparesis, hemiparesthesia Dysarthria, dysphagia, diplopia Circumoral numbness Imbalance Monocular blindness ```
35
Define CVA
Sudden loss of focal brain function
36
Types of CVA
Hemorrhage | Ischemia
37
Types of Hemorrhage CVA
Subarachnoid hemorrhage | Intracerebral hemorrhage
38
Types of Ischemic CVA
Thrombosis Embolism Systemic hypotension
39
Positive signs of CVA
Indicate active discharge from CNS neurons | Visual, auditory, somato-sensory, motor
40
Negative signs of CVA
Indicate absence or loss of function | Loss of vision, feeling, or ability to move a part of the body
41
CVA management
Ensuring medical stability Reversing conditions contributing to condition Uncover pathophysiologic basis of symptoms Screen for contraindications for TPA
42
Immediate studies for CVA management
``` Noncontrast CT EKG CBC with differential CMP PTT, PT, INR Oxygen Saturation Pregnancy test Blood cultures if fever ```
43
CVA treatment
``` Keep patient flat to 15 degrees BP between 140-160 to help perfuse Reverse effects of warfarin (hemorrhagic) TPA Antithrombotic therapy ```
44
Define Myasthenia gravis
Disorder of neuromuscular transmission affecting the ocular, bulbar, limb, and respiratory muscles
45
Management of Myasthenia gravis
Monitor FVC every 1-2 hours Elective intubation Plasmapharesis or IVIG
46
Define MS
Acute exacerbations that result in functionally disabling symptoms with objective neurologic impairment
47
Treatment of MS
High dose IV glucocorticoids | Treat seizures if they occur
48
Neuropathic Pain Syndromes
Determine if anything new or different about the pain being experienced
49
Treatment for neuropathic pain syndromes
IM dose of deluded or morphine 1 time PO opioid Start/increase prophylactic med Regular follow up with PCP or pain specialist
50
Guillian-Barre Syndrome
Symmetric ascending muscle weakness from the legs up Severe back pain Dysautonia
51
Guillian-Barre Syndrome Diagnosis
Lumbar puncture EMG Nerve conduction studies
52
Guillian-Barre Syndrome Treatment
Watch for respiratory failure Monitor heart rhythm, pulse, and BP Fluids Admission to ICU

Neurology (10 decks)

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